Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00392
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/17/2007
PARCEL: 1 S135AB -00100
SITE ADDRESS: 10350 SW LINCOLN ST ZONING: R-4.5
SUBDIVISION: TOWN OF METZGER LOT: 005 JURISDICTION: TIG
PROJECT: METZGER ELEMENTARY PORTABLES
Project Description: Limited energy for voice /data /catv.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TUALATIN SCHOOL DISTRICT AZIMUTH COMMUNICATIONS INC
6960 SW SANDBURG ST P.O. BOX 508
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503- 639 -0110
FAX 503- 639 -0115
FEES Reg #: ELE 36 -94CLE
L1C 145828
Description Date Amount SUP 2312LEA
[ELPRMT] ELR Permit 10/17/2007 $75.00
[TAX] 8% State Surcha 10/17/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules erect q ions to 0 NC at 503.246.6699 or 1.800.332.2344.
Issue By: Permiftee Signature: � ' ��. LA.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by - 7:00 -a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,
ElectFicalyermit Application FOR OFFICE: USE ONLY
City of Tigard Received !O i7 07 PermitNo.: ii... 44447 V3y
13125 SW Hall Blvd., Tigard, OR 97223 411 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 - .,e„,,_: I + I Daze/ Other Permit:
.
Inspection Line: 503.639.4175 '1 I ` Date ReadyBy. tuts:, 65 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: // /a Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction mi Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑Buildngover 10,000 sq. tt.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling EL Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION • ['Egress/lighting plan RV park
_ ❑Health -care facility ❑der:
Job no.: Job site address:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: 7-76,,,04, 02 / .w L, j pt . f ,) 4(e, The above are not applicable to temporary construction service.
. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee I Total I ..
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. Limited energy, non - residential / 75.00 . 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling
V6/ Ce1114 179-/0^ I/ / — �( � service and/orfeeder 90.90 2
7 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: -3 / i) 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I (gii CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Q 2, al COM iM u,✓ / C,tT1V,t/ C branch circuit
l B. Fee for branch circuits
Contact name: RDS II L - without service or feeder fee, 46.85 2
Address: PO, &� Each SDK
each a dd'1 branch branch circuit
/ circuit 6.65 2
City/State/ZIP: ( ,t/ /Ls' sae L) 73 Miscellaneous (service or feeder not included)
Phone: (5'3 T93 -2ge 9 Fax: : ) 3) t6 39 - U //S Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: A Z /Mu rp r 0/u ii/I 0,4 ramvs
Address: go. Q Q x 50a Each additional inspection over allowable in any of the above
,gyp Per inspection 62.50
City/ State/ZIP: 0/ L5 i J )l.. LLL . C� q71176 b76 Investigation per hour (1 hr min) 62.50
• Phone: 6 63 q_ )J /D Fax: U 3) 6 39 O //r Industrial plant per hour 73.75 -
_ ELECTRICAL PERMIT FEES*
CCB Lie.: (' 1{s�'ZZ Electrical Lie.: 34 -9 41 7j Suprv. Lic.: )3,1,2 t..6 7 ,DO
Subtotal
Suprv. Electrician signature, required: ye ll Plan review (25 %ofpermit fee) —tS
Print name: RQc/ 114 Date:-/-6 / / >/ ' State surcharge (8% of-permit-fee) fee) —6, .6C)
TOTAL PERMIT FEE g ( . 60
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
a AlEgui lding \Perm its \FLC- PermitApp.doc 12/03 4104615T(10/02/COM/WFB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: -
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved: •
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: BuildingWennnits \ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 L
INSPECTION WORKSHEET FOR DATE: 10/2&/2007 TIME: 7 :00AM PAGE: 60
SITE ADDRESS: 10350 SW LINCOLN ST CLASS OF WORK:
SUBDIVISION: TOWN OF METZGER LOT #: 005 TYPE OF USE:
PROJECT NAME: METZGER ELEMENTARY PORTABLES
DESCRIPTION: Limited energy for voice/data/caty.
•
OWNER: PHONE #:
CONTRACTOR: AZIMUTH COMMUNICATIONS INC S`j'sv r PHONE #: 603- 639 -0110
Inspection Request Scheduled For: Date: 10/26/2007 Pour Time:
Code # Inspection Description y Conf Contact # Message
199 Electrical final 05842801 503-793.2906 Y
-- ----- .mss
Corrections/Comments/Instructions:
PASS ❑ PARTIAL_APPR_QVAL El _CANCEL ❑ NO ACCESS____
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q t7 Date: V0I Phone #: (503) 718 - itito